Provider Demographics
NPI:1558635862
Name:IDEAL BALANCE INC
Entity Type:Organization
Organization Name:IDEAL BALANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-463-9100
Mailing Address - Street 1:6800 HERITAGE PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8746
Mailing Address - Country:US
Mailing Address - Phone:972-463-9100
Mailing Address - Fax:972-463-9109
Practice Address - Street 1:6800 HERITAGE PKWY
Practice Address - Street 2:STE 200
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8746
Practice Address - Country:US
Practice Address - Phone:972-463-9100
Practice Address - Fax:972-463-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156581Medicare PIN